Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montréal, Québec, Canada.
Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Vienna, Austria.
Can J Cardiol. 2021 Aug;37(8):1240-1247. doi: 10.1016/j.cjca.2021.03.019. Epub 2021 Mar 27.
Evidence differentiating the effect of biological sex from psychosociocultural factors (gender) in different societies and its relation to cardiovascular diseases is scarce. We explored the association between sex, gender, and cardiovascular health (CVH) among Canadian (CAN) and Austrian (AT) populations.
The Canadian Community Health Survey (CCHS) (n = 63,522; 55% female) and Austrian Health Interview Survey (AT-HIS) (n = 15,771; 56% female) were analyzed in a cross-sectional survey design. The CANHEART/ATHEART index, a measure of ideal CVH composed of 6 cardiometabolic risk factors (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes, and hypertension; range 0-6; higher scores reflecting better CVH) was calculated for both databases. A composite measure of psychosociocultural gender was computed for each country (range 0-1, higher score identifying characteristics traditionally ascribed to women).
Median CANHEART 4 (interquartile range 3-5) and CAN gender scores 0.55 (0.49-0.60) were similar to median ATHEART 4 (3-5) and AT gender scores 0.55 (0.46-0.64). Although higher gender scores (CCHS: β = -1.33, 95% confidence interval [CI] -1.44 to -1.22; AT-HIS: β = -1.08, 95% CI -1.26 to -0.89)) were associated with worse CVH, female sex (CCHS: β = 0.35, 95% CI (0.33-0.37); AT-HIS: β = 0.60, 95% CI (0.55-0.64)) was associated with better CVH in both populations. In addition, higher gender scores were associated with increased prevalence of heart disease compared with female sex. The magnitude of this risk was higher in Austrians.
These results demonstrate that individuals with characteristics typically ascribed to women reported poorer cardiovascular health and higher risk of heart disease, independently from biological sex and baseline CV risk factors, in both countries. Female sex exhibited better CV health and a lower prevalence of heart disease than male in both populations. However, gender factors and magnitude of gender impact varied by country.
在不同的社会中，区分生物性别与心理社会文化因素（性别）对心血管疾病影响的证据很少。我们探讨了加拿大（CAN）和奥地利（AT）人群中性别、性别认同和心血管健康（CVH）之间的关系。
采用横断面调查设计，对加拿大社区健康调查（CCHS）（n=63522；女性占 55%）和奥地利健康访谈调查（AT-HIS）（n=15771；女性占 56%）进行分析。计算了 CANHEART/ATHEART 指数，这是一个由 6 个心血管代谢风险因素（吸烟、体力活动、水果和蔬菜摄入、超重/肥胖、糖尿病和高血压；范围 0-6；分数越高代表 CVH 越好）组成的理想 CVH 衡量标准，这两个数据库都可以计算。为每个国家计算了一个心理社会文化性别综合衡量标准（范围 0-1，分数越高表示具有传统上认为是女性的特征）。
加拿大的中位 CANHEART 得分为 4（四分位距 3-5），CAN 性别得分为 0.55（0.49-0.60），与奥地利的中位 ATHEART 得分为 4（3-5）和 AT 性别得分为 0.55（0.46-0.64）相似。尽管较高的性别得分（CCHS：β=-1.33，95%置信区间[CI] -1.44 至-1.22；AT-HIS：β=-1.08，95%CI -1.26 至-0.89）与较差的 CVH 相关，但女性性别（CCHS：β=0.35，95%CI（0.33-0.37）；AT-HIS：β=0.60，95%CI（0.55-0.64））在两个群体中都与更好的 CVH 相关。此外，与女性相比，较高的性别得分与心脏病患病率的增加相关。这种风险的幅度在奥地利人更高。
这些结果表明，在这两个国家中，具有传统上认为是女性特征的个体报告的心血管健康状况较差，心脏病风险较高，而与生物性别和基线 CV 风险因素无关。在两个群体中，女性的 CV 健康状况更好，心脏病患病率低于男性。然而，性别因素和性别影响的幅度因国家而异。
